Substance Use
Modeling Canada’s Opioid Crisis: A Systems Approach to Policy and Intervention Strategies Zeynep Hasgul* Zeynep Hasgul Hesam Mahmoudi Rebecca Plouffe Tara Sadeghieh Karin Johnson Eva Graham Mohammad S. Jalali
The opioid crisis continues to impose a profound public health burden, with recent trends in Canada paralleling the trajectory of the epidemic in the United States. This study builds on the SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects) model, a system-level quantitative framework developed in collaboration with the U.S. Food and Drug Administration and recommended by the U.S. National Academies of Sciences, Engineering, and Medicine to guide integrated policy decisions. Recognized for its evidence-driven approach, SOURCE incorporates feedback mechanisms—such as drug availability, social influence, and risk perception—that capture the complex, dynamic nature of opioid use and overdose. By adapting and recalibrating SOURCE to the Canadian context, this study enhances our understanding of Canada’s opioid crisis dynamics and provides a robust tool to evaluate tailored policy interventions. This Canadian adaptation incorporates key differences in opioid use patterns, such as the availability and coverage of medications for opioid use disorder (MOUD) and policy contexts. Structural modifications to the model reflect the widespread accessibility of buprenorphine in Canada and the absence of Vivitrol. Using data from Canadian surveys, IQVIA, and public health datasets between 2009 and 2023, the model was recalibrated to estimate Canadian-specific opioid use trajectories, overdose rates, and MOUD treatment outcomes. The adapted model evaluates the future impacts of nine current and new strategies in Canada, spanning harm reduction, MOUD expansion, prevention of misuse, and recovery support, to provide insights into policy and intervention effectiveness. We present portfolios of intervention combinations and their projected reductions in overdose deaths over time with the highest potential reductions observed when integrating multiple strategies across prevention, harm reduction, and treatment.